Oncology - Brain tumours in children

Question 1

Definition

Answer 1

A brain tumour is an abnormal growth occurring in any tissue contained within the cranium, including the brain, cranial nerves, meninges, skull, pituitary gland and pineal gland

Question 2

Aetiology

Answer 2

Genetic factors:
- Neurofibramotosis type 1
- Von-Hippel-Lindau
- Li-Fraumeni syndrome
Environmental factors:
- Ionising radiation
- Maternal Exposure
- Chemical exposure

Question 3

Astrocytoma

Answer 3

Primary tumour of the brain arising from astrocytes (makes up blood-brain barrier)
- MC brain tumour in children
- Can grow all throughout brain but MC Infratentorial tumour
- Mostly grow in the cerebellum and close to brainstem
- Graded 1 (pilocytic astrocytoma) - Grade 4 (glioblastoma multiforme)
- Pilocytic astrocytoma histology: Rosenthal fibres (corkscrew eosinophilic bundle) - - Grade 1 tumours have an excellant prognosis

Question 4

Medulloblastoma

Answer 4

• 2nd MC brain tumour in children
• H.aggressive paediatric brain tumour that arises within the infratentorial compartment. It spreads through the CSF system
• Histology: Small, blue cells. Homer-Wright Rosette pattern of cells with many mitotic figures

Question 5

Meningioma

Answer 5

• Typically benign tumour of arachnoid cells of the meninges
• They typically are located at the falx cerebri, superior sagittal sinus, convexity or skull base
• Histology = Spindle cells in concentric whorls and calcfied psammoma bodies.

Question 6

Craniopharyngioma

Answer 6

• Solid/cystic tumour of the sellar region that is derived from the remnants of Rathke’s pouch.
• MC paediatric supratentorial tumour
• It may present with hormonal distrubances, symptoms of hydrocephalus or bitemporal hemianopia
• Histology = derived from remnants of Rathke pouch

Question 7

Ependymomas

Answer 7

Infratentorial tumour:
- Tumours of the cells of the ventricular system
- Commonly seen in the 4th ventricle
- May cause hydrocephalus
- Histology = perivascular pseudorosettes

Question 8

Tumours that spread to the brain

Answer 8

Lung,
Breast,
Bowel,
Skin,
Kidney

Question 9

Symptoms

Answer 9

• Persistent headaches that are worse in the morning
• Signs of raised ICP
• Seizure in an older child with no fever and no previous history of seizures.

Question 10

Diagnosis

Answer 10

FIRST LINE = Suspected space occupying lesions are investigated with imaging of the brain (CT or MRI)

Question 11

Treatment

Answer 11

Highly dependant on the tumour site, size, type, and staging.
Requires specialist input and MDT management, and may involve chemotherapy, radiotherapy, and surgery